What's Your Pregnancy IQ?

You know you should eat right, avoid alcohol and tobacco, and put your career as a trapeze artist on hold until after the baby’s born. You might even know what kinds of fish you can safely eat. But how well-versed are you in the finer points of building a healthy baby? Take our quiz to find out, then check out our answers that will turn you into a maternity maven.

Circle your answers, then turn the page to find out how pregnancy-savvy you really are.

1) Why should you seek prenatal care early in pregnancy? a. to detect the baby’s heartbeat b. to get an accurate due date c. to monitor existing medical problems d. both b and c

2) As soon as you find out you’re pregnant, you should discontinue any medications you may be taking. a. true b. false

Here are the correct answers. They’ll tell you just how much you know, and what you could stand to learn a thing or two about.

1) answer: d Many doctors and midwives like to see women early in pregnancy so they can gather information to be used at the end: namely, the baby’s due date. Why is an accurate due date so important? “About a week past the due date, the placenta may start to break down, so we want to make sure the baby’s heart rate is OK and that there’s enough fluid around him. If not, we may need to induce labor,” says Pamela Berens, M.D., associate professor of OB-GYN at the University of Texas Medical School at Houston. “If a woman has a perfect 28-day cycle, getting an accurate due date isn’t much of an issue,” Berens adds. “Otherwise, we can do an ultrasound to date the pregnancy, and that’s the most accurate way to do it in the first 12 weeks.” Having an accurate due date is also important when it comes to fetal screening, according to Mayri Sagady Leslie, R.N., C.N.M., director of the University of California, San Diego, Nurse-Midwife and Birth Center. “The AFP [alpha-fetoprotein] test is time-

sensitive and needs to be done between 15 and 20 weeks,” she says. “This window is the only time it can be done.”

Screening for existing health problems is another chief reason to get prenatal care early, says Gideon Koren, M.D., founding director of the Motherisk Program at Toronto’s Hospital for Sick Children and author of The Complete Guide to Everyday Risks in Pregnancy and Breastfeeding (Robert Rose, 2004). For instance, if you have high blood pressure, diabetes, epilepsy or other health problems, your doctor will want to make sure the condition is under control and that any medications you’re taking are pregnancy-safe. (This also is why experts recommend seeing a doctor before becoming pregnant, if possible.) So why is looking or listening for a heartbeat not at the top of the list? Simply because very early on in pregnancy, it may be too hard to detect. “Not seeing a heartbeat before six weeks doesn’t mean much,” Berens says. “But no heartbeat after six weeks could indicate a problem.” 2) answer: b “Don’t go cold turkey or change any medications you’re taking without consulting your doctor,” Koren says. “There are many conditions, including depression and asthma, that require ongoing treatment, and if you alter your medications suddenly because you’re pregnant, you could harm yourself, as well as your baby.”

3) answer: c Eeeww, but true. Toxoplasmosis is an infection caused by the Toxoplasma gondii parasite. Most adults who contract the infection have mild flulike symptoms or no symptoms at all. But the parasite can cross the placenta and cause significant risk to the fetus, including lifelong problems with the brain, eyes, heart and other organs.

The parasite can be transmitted a number of ways, the most common of which is by eating infected meat that hasn’t been cooked sufficiently to kill the parasite, according to geneticist and OB-GYN Karen Filkins, M.D., a clinical professor at the University of California, Irvine. Other risky food sources include unpasteurized milk and raw eggs, as well as fruit and vegetables that have not been washed thoroughly.

Cats also can carry the disease if they eat raw meat or rodents; since the parasite can be passed on through feline feces, pregnant women should wear gloves when gardening and designate the litter box duties to someone else. Interestingly, while dogs can become infected with toxoplasmosis, they cannot transmit the parasite, as it can only complete its life cycle in domestic cats.

4) answer: d While many experts recommend taking 400 micrograms of folic acid daily, the researcher who demonstrated this B vitamin’s role in preventing neural-tube defects says the dosage should be increased about tenfold. Nicholas Wald, F.R.C.P., F.R.S., director of the Wolfson Institute of Preventive Medicine and professor of environmental and preventive medicine at Barts and The London School of Medicine and Dentistry, recommends that all women start taking 5 milligrams of folic acid daily two weeks before trying to conceive and continuing that dosage for at least the first 12 weeks of pregnancy.

“Taking .4 milligrams [400 micrograms] of folic acid will prevent about 40 to 50 percent of neural-tube defects,” Wald says. “Taking 5 milligrams will prevent about 80 percent.” While the American College of Obstetricians and Gynecologists (ACOG) recommends that women who have had a child with a neural-tube defect take 4 milligrams of folic acid daily and that others take 400 micrograms, Wald points out that there are no risks associated with the higher dosage.

Folic acid is available either by prescription or over the counter. If you don’t have a prescription, find a supplement that contains only folic acid; taking higher doses of a multivitamin could lead to toxic levels of other nutrients, such as vitamin A.

5) answer: a Products such as hair dyes, perms and straighteners have not been shown to pose a risk to the average pregnant woman, Filkins says. (Women who work in the beauty industry and are therefore exposed contin-uously, and in larger amounts, to the chemi-cals in these products may have a higher risk of miscarriage.) To be on the safe side, wait until after the first trimester to have any of these treatments done. In addition, limit hair coloring to once every eight weeks. Switch from permanent color, which sits on your scalp, to highlights, as dye may be absorbed into the bloodstream through the scalp.

Nail polish and self-tanners also have not been proven unsafe, but limit unnecessary exposure. Some nail polish brands now offer formulas free of a suspect chemical, dibutyl phthalate (DBP), but not all list their ingredients. And choose a nail salon with good ventilation. “The less ventilation, the bigger the exposure,” Filkins says. Self-tanners do not seep into the skin; still, it’s prudent to avoid applying these products to your belly while pregnant and to your breasts if you are nursing.

Acne medications are another story: Some can cause severe birth defects. “High doses of vitamin A should be avoided,” Filkins says. “Retin-A, which contains a vitamin A derivative, poses a theoretical risk, but Accutane is definitely dangerous.” To be safe, don’t use either. In fact, you should stop using both at least one month before trying to get pregnant.

Even riskier is Etretinate, a psoriasis medication. “Etretinate stays in the body for a very long time—up to two years—so it isn’t a concern just during pregnancy,” Filkins explains. “It shouldn’t be used at all if you’re planning a pregnancy any time in the future.”

6) answer: b Most women can have sex up until the day they deliver without fear of bringing on premature labor. However, if you have had preterm-labor symptoms during this or a previous pregnancy, if your water has broken or if you have had problems with bleeding, your doctor may ask you to abstain from intercourse. “But that’s the exception, not the rule,” Berens says.

Prolonged standing—working full-time as a cashier, for example—is linked to preterm labor, as is contracting some vaginal infections during pregnancy.

Finally, the births of as many as 18 percent of preterm, low-birth-weight babies in the United States each year may be attributed to their mothers’ gum disease, according to the National Institute of Dental and Craniofacial Research. Scientists theorize that bacteria in tooth plaque send toxins into the mother’s bloodstream and then cross the placenta, interfering with fetal growth and development.

7) answer: a If you’ve been choking down liver and onions for their supposed health benefits, you can—and should—take a breather. Because an average portion of liver can contain four to 12 times the recommended dietary allowance (RDA) of vitamin A (too-high amounts of which can cause urinary tract and central nervous system anomalies in the fetus), some experts recommend avoiding this organ meat altogether in early pregnancy. Others suggest limiting your intake of liver and liver products (such as duck liver pâtés and some sausages) to 4 ounces per week during pregnancy.

8) answer: a Studies have not shown the flu vaccine to pose risks to a pregnant woman or her baby. In fact, because pregnant women are at increased risk of flu complications, ACOG now recommends that all women receive the flu shot before or during pregnancy, regardless of what trimester they are in. “It’s dangerous for pregnant women to get the flu because it can progress to pneumonia,” Filkins explains.

Fever is another concern, as animal studies indicate that there is a higher risk of neural-tube defects with an increase in body temperature. Fever also can cause uterine irritability, which can lead to preterm labor. If you have a fever of more than 101 F, Filkin suggests calling your doctor right away.

9) answer: b Gaining too much weight puts you at risk for developing gestational diabetes and having an overly large baby and, perhaps, a Cesarean section. But gaining less than 15 pounds can lead to a too-small baby. So pay attention to these ACOG guidelines: Overweight women should aim to gain 15 to 25 pounds; obese women, at least 15 pounds; normal-weight women, 25 to 35 pounds; and underweight women, 28 to 40 pounds. (Note: In response to the rapidly increasing numbers of overweight and obese people in this country, some experts are calling for a re-evaluation and updating of the current weight-gain recommendations. For details, see “Face-Off” on pg. 27.) 10) answer: d Caffeine in moderate amounts has not been shown to increase the risk of miscarriage or birth defects, so if you’re used to your morning cup of java, go ahead and enjoy it. But beware—caffeine can lurk in unexpected places:

8 ounces coffee: 65 to 120 milligrams

2 Excedrin tablets: 130 milligrams

8 ounces hot chocolate: 5 milligrams

1 cup Häagen-Dazs coffee ice cream: 58 milligrams

16 ounces decaf Starbucks coffee: 10 milligrams

How’d you score?10 correct answers Send your résumé to Fit Pregnancy today! Your knowledge level is awesome. 7–9 Your knowledge is generally up-to-date, but you may need a brush-up in some areas. 4–6 You may be getting some of your information from outdated or unreliable sources. Update your knowledge through reputable websites, current books, magazines like this one and your OB or midwife. –3 Don’t feel bad—nobody knows all the answers. Just don’t hesitate to talk with your doctor or midwife about any questions you might have.

The Organization of Teratology Information Services sets the record straight on what does or may cause birth defects. More than 40 fact sheets provide comprehensive, reader-friendly information on everything from chemotherapy to herbal products to vaccinations. Visit www.otispregnancy.org